Toward improved understanding and treatment of self‐injurious behaviors in autistic individuals with profound intellectual disability.

Self‐injurious behaviors (SIB) commonly occur in autism spectrum disorder (ASD) and span diverse topographies of self‐inflicted behaviors ranging from head banging to hitting oneself against hard objects. Despite the high rates of SIB in autistic individuals, relatively little research has focused on psychological factors associated with the development and maintenance of SIB in individuals with autism and moderate‐profound intellectual disability (ID). This commentary synthesizes existing literature on SIB and highlights the need for more research focused on psychological correlates and mechanisms in autistic individuals with moderate‐profound ID. We highlight the key role of difficulties in emotion regulation (ER) and co‐occurring internalizing symptoms in the manifestation of self‐harm behaviors in clinical samples and autism. Furthermore, this commentary proposes a framework for understanding the interplay between poor ER and internalizing symptoms in the development and maintenance of SIB in autistic individuals with moderate‐profound ID. Specifically, we explore the emergence of SIB in the context of precipitating cues that trigger strong emotions, ER processes and strategy deployment, and co‐occurring internalizing symptoms. Future directions and implications for longitudinal research, measurement development, and clinical treatments are discussed. Lay Summary: Although research has shown that many autistic people with moderate‐profound intellectual disability engage in self‐injurious behaviors (SIB), factors that might contribute to these clinically impactful behaviors are not well understood. This commentary aims to address this knowledge gap by summarizing current information and making a specific set of suggestions on how we can improve our understanding of factors related to SIB in autism and intellectual disability, with the ultimate goal of designing effective interventions that can improve the wellbeing of autistic people. [ABSTRACT FROM AUTHOR]